Abstract: Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women’s choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women’s autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women’s autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all.
Anorexia Nervosa: Psychopathology as the Crystallization of Culture
Diversifying Syllabi: Bordo claims that the recent increase in women with Anorexia is a symptom of the “central ills” of our culture. Bordo discusses three sources of this “cultural illness” which leads to anorexia: the dualist axis, the control axis, and the gender/power axis. She spends the bulk of the paper discussing each “axis” or problematic component of society which is reflected back to us in the increasing diagnosis of anorexia. These “psychopathogolgies” are expressions of the culture, she claims.
Medical Ethics Needs a New View of Autonomy
Abstract: The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order.
A Human Right to Health? Some Inconclusive Scepticism
Abstract: This paper offers four arguments against a moral human right to health, two denying that the right exists and two denying that it would be very useful (even if it did exist). One of my sceptical arguments is familiar, while the other is not.The unfamiliar argument is an argument from the nature of health. Given a realistic view of health production, a dilemma arises for the human right to health. Either a state’s moral duty to preserve the health of its citizens is not justifiably aligned in relation to the causes of health or it does not correlate with the human right to health. It follows that no one holds a justified moral human right to health against the state.Education and herd immunity against infectious disease both illustrate this dilemma. In the former case, the state’s moral duty correlates with the human right to health only if it demands too much from a cause of health; and in the latter, only if it demands nothing from a cause of health (that is, too little).
The Nonidentity Problem
Introduction: The nonidentity problem focuses on the obligations we think we have in respect of people who, by our own acts, are caused both to exist and to have existences that are, though worth having, unavoidably flawed – existences, that is, that are flawed if those people are ever to have them at all. If a person’s existence is unavoidably flawed, then the agent’s only alternatives to bringing that person into the flawed existence are to bring no one into existence at all or to bring a different person – a nonidentical but better off person – into existence in place of the person whose existence is flawed. If the existence is worth having and no one else’s interests are at stake, it is unclear on what ground morality would insist that the choice to bring the one person into the flawed existence is morally wrong. And yet at the same time – as we shall see – it seems that in some cases that choice clearly is morally wrong. The nonidentity problem is the problem of resolving this apparent paradox.
The problem raises the question whether the (usually significant) good that an agent confers along with existence counterbalances the (usually limited) bad that an agent confers along with any unavoidably flawed existence in such a way that our existence-inducing act (usually) will be deemed permissible. And if it isn’t – if we think instead that obligations are left unsatisfied despite the good that comes with existence – is the moral of the story that moral obligation extends beyond what we must do for people? If we agree, in other words, that it is our obligation to create additional good, is it enough that we create additional good for each and every existing and future person? Or does the nonidentity problem show that our focus should instead be on creating additional good for the universe? As we query how to evaluate existence-inducing acts for their moral permissibility – as well as outcomes or possible futures or worlds, for their moral betterness against still other worlds – we find that some of our most deeply held intuitions regarding the nature and structure of morality are thrown into doubt.
The responsibility of psychopaths
Content: The paper examines various arguments looking at the responsibility psychopaths bear for their immoral actions, using neurological knowledge about psychopathy.
Mental Disorders and the “System of Judgmental Responsibility”
Diversifying Syllabi: Thesis: Those affected by mental disorders whose actions are episodically influenced by their disorder are often overlooked by philosophers of moral and ethical responsibility. Allen gives us reasons for thinking it is inappropriate to either:
a) “summarily exclude people with mental problems out of the universe of moral agents, reducing them to the status of rocks, trees, animals, and infants”
b) “include the group on the false assumption that their moral lives are precisely like the paradigmatic moral lives of the epistemically-sound and well-regulated people never personally touched by a mental condition”
We must explore a revised approach to moral and ethical responsibility and obligation for this group.
Some limits of informed consent
Abstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.